Assessment of the lipodermal flap for avoidance of lateral dog-ear deformity in mastectomy

Abstract

Background Patients who are at an elevated risk of developing lateral dog ears deformity following mastectomy, such as those who have high body mass index, or who have too much tissue in the lateral chest wall, and who are not ideal candidates for immediate reconstruction or the Goldilocks mastectomy, should have a lateral dog-ear assessment and should consider the lipodermal flap technique. The purpose of this study was to explain a modification to the mastectomy incision known as the lipodermal flap procedure that avoids this deformity and improve patient satisfaction and quality of life. Methods This study included 50 female breast cancer patients who were recommended for a modified radical mastectomy (MRM); they had large cup-size breasts and were expected to develop a dog-ear deformity after the mastectomy. Results The type of mastectomy was MRM in 48 patients, and palliative toilet mastectomy in only two patients. The operative time median is about 1.5 h (1.5–1.5), the wound length median is about 20 cm (19–20), and the blood loss median is about 200cc (180–220). Scar discomfort: 45 patients (90%) did not experience scar discomfort, and five patients (10%) felt scar discomfort. Regarding wound dehiscence, 46 patients had no wound dehiscence and four patients (8%) had wound dehiscence and 48 patients (96%) had no flap necrosis and 2 patients (4%) had flap necrosis. Cosmetic result: 4 patients (8%) with wound cosmesis were not accepted and 46 (92%) patients were accepted; 46 (92%) patients were satisfied; 100% of the cases had no dog ear in the lateral part of the mastectomy scar. Conclusions The lipodermal flap technique is safe, feasible, and reliable and could be applied during MRM once lateral dog-ear deformity is anticipated with a high satisfaction rate and lower incidence of wound complication.